Adult hip conditions and surgery Flashcards
can you make more hyaline cartilage
no
what is femoroacetabular impingement syndrome (FAI)
when altered morphology of the femoral neck and/or acetabular causes impingement of the femoral neck on the edge of the acetabulum during movement
what movement usually cause FAI
flexion, adduction and internal rotation (pulling on your shoe)
what is a CAM type impingement in FAI
femoral deformity- asymmetric femoral head with decreased head:neck ratio
who gets a CAM type FAI
usually young, athletic males
can be related to previous SUFE
what is a pincer type inpingement in FAI
acetabular deformity- acetabular overhang (extra bit of bone or acetabular tilted forward)
what does FAI cause in the joint
damage to the labrum and tears
damage to the cartilage
osteoarthritis in later life
what is the usual presentation of FAI
activity related pain in the groin- particularly flexion and rotation
difficulty sitting
C sign positive
FADIR provocation test positive
what is C sign positive
when patients with FAI are asked to describe their pain they will make a c shape with their hand and place it around hip joint
what is the FADIR provocation test
flexion, adduction, internal rotation- if maneuver produces pain suggestive of hip impingement
what can you diagnose FAI
radiographs, CT, MRI (better for visualising damage to labrum and bony oedema)
what is the management for FAI
observation in asymptomatic patients
arthroscopic or open surgery to remove CAM/ debride labral tears
periacetabular osteotomy/ debride labral tears in pincer impingement
arthroplasty older patients with secondary OA
what is avascular necrosis
failure of the blood supply to the femoral head resulting in subsequent necrosis
what causes AVN
idiopathic:
- coagulation of the intraosseous microcirculation
- venous thrombosis causes retrograde arterial occulsion
- intraosseous hypertension
- decreased blood flow to the femoral head
- necrosis of the femoral head
- chondral fracture and collapse
AVN associated with trauma
-injury of femoral head blood supply (medial femoral circumflex)
who gets avascular necrosis and in which hip?
males more than females
typical age 35-50
80% of cases bilateral
what are the risk factors for AVN
irradiation,
trauma,
haematologic diseases (leukemia, lymphoma), sickle cell,
hypercoagulable staes,
dysbaric disorders (decompression sickness ‘the bends’ aka the bends)
alcoholism,
steroid use,
most cases idiopathic
what is the usual presentation of AVN
insidious onset of groin pain,
exacerbated by stairs or impact,
examination is usually normal unless disease has advanced to collapse/ OA
how can AVN be diagnosed
radiographs (normal in early disease)
MRI is most sensitive and specific
what is the management for AVN dependent on
based on the stage of disease:
reversible
irreversible
what is the management of avascular necrosis
if reversible: bisphosphonates core decompression +/- bone grafting curettage and bone grafting vascularised fibular bone graft
rotational osteotomy
total hip replacement
(if irreverisble)
what is idiopathic transient osteonecrosis of the hip (ITOH)
local hyperaemia and impaired venous return with marrow oedema and increase intraedullary pressure
how does ITOH usually present
progressive groin pain over several weeks
difficulty weight bearing
usually unilateral
who gets ITOH
males more than females
usually: middle ages females and pregnant women in third semester
how do you diagnose ITOH
elevated ESR
radiographs: osteopenia of the head an neck, thinning of the cortices, preserved joint space
MRI (gold standard)
bone scan
how is ITOH managed
self limiting condition that resolves in 6-9 months
analgesia so they can keep moving
protected weight bearing to avoid stress fracture
what is trochanteric bursitis
repetitive trauma caused by iliotibial band tracking over trochanteric bursitis causing inflammation of the bursa
who gets trochanteric bursitis
female patients, young runners and older patients (gluteal cuff syndrome- degenerative of)
how does trochanteric bursitis
pain on LATERAL aspect of the hip
pain on palpation of the greater trochanter
how do you diagnose trochanteric bursitis
clinical diagnosis
radiographs usually unremarkable
visible on MRI but not usually needed
how is trochanteric bursitis managed
analgesia, NSAIDs, physio, steroid injection
no benefit from surgery
what is osteoarthritis
degenerative disease of synovial joints that causes progressive loss of articular cartilage
inflammatory changes in the capsule lead to thickening and tightness
who gets OA
females more than males, typically in older age, genetic element, pre existing hip disease
what is the usual presentation of hip OA
groin pain, worse on activity, pain at night, start up pain (after resting for a while- lack of synovial fluid to lubricate the joint)
stiff on testing ROM
what determines if a patient gets surgery for OA
level of symptoms impact of QOL medical comorbidities social history do they want surgery
what are the radiographic signs of OA
loss of joint space
osteophytes
subchondral sclerosis
subchondral cyst formation
what is the management for OA
analgesia, weight loss walking aids, physio if weakness, ?steroids
THR
what is the main indication for THR in OA
pain
